347001903-11-29-2022-27-AS-CACL-CLTTH9-20221205134423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001903
Report Date: 11/29/2022
Date Signed: 11/29/2022 03:54:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/21/2022 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20221121142625

FACILITY NAME:	IVY RIDGE ASSISTED LIVING		FACILITY NUMBER:	347001903
ADMINISTRATOR:	REBECCA MCFADDEN		FACILITY TYPE:	740
ADDRESS:	2030 23RD STREET		TELEPHONE:	(916) 455-8849
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	36	CENSUS: 30	DATE:	11/29/2022
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Hong Trinh		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Insufficient staffing to meet the residents’ needs
Staff are not ensuring that residents are provided with bathing assistance
Facility has foul odors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced on 11/29/22 at 9:05 am to open a complaint with the allegations mentioned above. LPA met with Administrator Hong Trinh aka Zoe Zheng and explained the purpose of the visit.

During this visit, LPA Truong toured the facility and conducted interviews with residents and staff (See confidential name list LIC-811 dated 11/29/2022).

Based on statements obtained and LPA’s observation, the facility was not found to have any foul odors during today’s visit. 7 out of 8 residents who were interviewed stated that they did not notice any foul odors in the facility. 1 out of 8 residents stated sometime there’s a bad smell, but it’s just really quick. In addition, all residents stated that they believe the facility has adequate staffing.

Report continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20221121142625

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: IVY RIDGE ASSISTED LIVING	FACILITY NUMBER: 347001903
	VISIT DATE: 11/29/2022

NARRATIVE

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Moreover, 2 out of 8 residents who were interviewed stated staff provided assistant with bathing. 6 out of 8 residents stated they don't need any assistant with bathing.

As a result of this investigation, LPA finds the allegations above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC9099 (FAS) - (06/04)

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